"Suppose you're thinking about a plate of shrimp. Suddenly someone will say 'plate' or 'shrimp' or 'plate of shrimp,' out of the blue. No explanation and there's no point in looking for one either. It's all part of the cosmic unconsciousness."
Tracey Walter as "Miller" in "Repo Man"

Monday, July 11, 2005

Blow Into This End

There is an old story about some English orchestral conductor, maybe it was Sir Adrian Boult, who was notorious for his short rehearsals. He had the orchestra start up the first few measures of Brahms' Third Symphony, then stopped the players and said, "Well that sounds pretty good. I'll see you all tonight at the performance."

The story continues with one of the French horn players, a new hire to the orchestra, protesting, "But Maestro, aren't we going to rehearse the whole thing? Why, I've never even played in it before!"

To which the maestro replied "Oh, well it's a great symphony. You'll really like it."

I would thusly amend the story: suppose one of the horn players got sick, and the conductor asked the new violinist just to take over on the French horn part. The violinist would protest that not only was he not entirely familiar with the Brahms Third, but would add that he himself did not even play horn.

Nurses do this all the time. It's called "floating," and it is generally accepted that a nurse will not be asked to go work on another specialty unit about which they have no expertise. For example, a male geriatric psych nurse would not be expected to float to an OB-GYN unit.

Well, probably not.

Recently I had the pleasure of finding that it was my turn to float, and that I was going to spend the day on the Spine unit. Alrighty then. I had never worked on one before. I hoped it would not be as difficult as learning to play the French horn.

Just the thought of floating, anywhere, gave me a little PTSD, because the last time I did was Christmas and one of my patients went to CAT-scan, where he pulled out his foley catheter, went over the bedrails, fell, and was found a bloody mess. I punched out at 9 p.m. that day. Merry Christmas to me.

Though unfamiliar with the Spine unit itself, the patients were basically no clinical challenge. I sent one home, two others were "walkie-talkies" who only needed the occasional pain medication and TLSO brace application.

I took a post-op who was only sent to Spine because he needed to wear an Aspen collar until morning. His neck and head CAT's were OK. His legs were all banged up from a motor vehicle head-on. I kept him all liquored up on morphine and zofran and consoled his parents, explaining everything I could. People like explanations, and I like explaining things.

The real fun began when I got report to take a patient from one of the surgical ICU floors. Among other things, the patient had a cervical corpectomy at C-3 through C-6.

"Whatever that is," I said to myself as I took report over the phone. He also had a Halo on, and I sort-of knew that that was one of those things where they put screws in your head and fixate them to a ring brace so your neck is immobile. Cool.

On tube feedings and Yankauer suctioning (which he even did himself,) and pretty stable, he sounded a lot more complicated on paper than he did when I finally got to working with him. It helped that he was a very sweet and simple person who said "thank you" and was very cooperative in his care. He tried, instead of wimping out like some people do, and for that I have great respect. He was blessed by a good attitude and general innocence.

The other nurse was very competent, low-key, and easy-going. Helpful to the maximum.

Interestingly, at one time I walked by the nurse's station to see him and one of the orthopedic nurse practitioners looking at the website I linked above, because he himself was not entirely familiar with the term "corpectomy." (Great website, by the way. Groovy animation.)

The day ended undramatically. The oncoming nurses were a hoot, and told a couple jokes during our report off. Listening to myself, I even sounded a little like I knew what I was talking about. I at least still knew what the day had taught me, it being so fresh in my mind.

And it taught me well.

While going home, I realized that I had never before cared for a patient with that kind of Halo.

Great post! I've finally gotten around to putting up new links at http://mediblogopathy.blogspot.com and I've included your blog. I also really liked that Dr. Dillin's spine page. Stop by and grab a NurseBlogs logo badge if you like. I'll be back to read more!